Health systems that were early entrants into the specialty pharmacy realm have reaped considerable benefits as the industry has matured, causing their peers to stand up and take notice. These benefits include:
- Enhancing their ability to service more disease states
- Finding ways to leverage their services
- Working closely with providers to ensure wraparound services for specialty pharmacy
- Improving patient navigation and support
This week, host Andrew Maddigan, Vice President, Client Engagement welcomes Brendan Reichert, Senior Vice President of Health System and IDN Consulting at CSI Specialty Group, to share insights on the 2019 State of Specialty Pharmacy Report and reveal where the market may be heading in the future.
Tune in to Discover:
- How to help drive demand for health system specialty pharmacies
- The evolution of health system relationships with payors/PBMs
- Health system specialty pharmacy challenges to growth
- How to create efficiencies in health system specialty pharmacy
About Brendan Reichert, RPh, MS
Brendan Reichert, MS, Rph, is the IDN and Health System Senior Vice President responsible for the planning, contracting, implementation, and post-activation stabilization of new service lines. Serving as the project manager for several large scale projects (facility build-out, clinical applications, and operational projects). Mr. Reichert received his Bachelor of Science degree in Pharmacy and his Master of Science in Health System Pharmacy Administration from The Ohio State University in Columbus, Ohio. Mr. Reichert completed a Pharmacy Practice / Health-System Pharmacy Administration Resident (PGY1 / PGY2) at Grant Medical Center- OhioHealth in Columbus, Ohio.
Mr. Reichert began his career at Grant Medical Center- OhioHealth as an operations manager in the Pharmacy Department. He became the Clinical Applications Manager for the OhioHealth Information Services Department and had responsibilities for clinical applications across the OhioHealth healthcare system. From 2008 to 2012, Mr. Reichert served as the Assistant Director- Med Use Informatics at The Johns Hopkins Hospital in Baltimore, Maryland. Most recently, Mr. Reichert led the specialty pharmacy build-out project for Johns Hopkins.
Mr. Reichert is an active member in Healthcare Information and Management Systems Society (HIMSS), Project Management Institute (PMI), and the American Society of Health-System Pharmacists (ASHP). He also sits on the ASHP Pharmacy Online Residency Centralized Application Service (PhORCAS) Advisory Committee.
About Andrew Maddigan
During the past 30 years, Andrew Maddigan has directed business strategy and marketing functions in a wide range of venues, including health care, education, aerospace, and energy. His previous roles have included VP of marketing for the nation’s largest not-for-profit hospice agency, VP of sales and marketing for a national specialty and long-term care pharmacy and communications director at a large urban school district.
Andrew also led marketing and strategic communications efforts for an international health care accreditation agency, serving as the organization’s liaison to the United Nations Development Program. Andrew earned his BS in Broadcast Journalism from the S.I. Newhouse School of Public Communications at Syracuse University. He earned an MS in Educational Administration from Canisius College and an MBA from St. Bonaventure University. He currently serves as VP of client engagement at CSI Specialty Group.
Andy Madigan: Hello and welcome to the CSI Specialty Pharmacy podcast. I’m Andy Maddigan, CSI’s Vice President of Client Engagement and your host for this episode. Today, we welcome Brendan Reichert, CSI’s Senior Vice President of Health System and IBM Consulting. Brendan is a graduate of the Ohio State University School of Pharmacy. He has spent most of the last 20 years working in health system pharmacies, everything from daily operations to health system informatics, application implementation, training, and hospital-based specialty pharmacy. Welcome, Brendan.
Brendan R.: Thank you, Andy.
Andy Madigan: I think our listeners are going to really enjoy hearing about your perspective on the 2019 state of specialty pharmacy report. This year’s report is based on responses to a survey of four key stakeholder groups in specialty pharmacies. So we’ve got pharmaceutical manufacturers, health systems, specialty pharmacies, independent specialty pharmacies, and third party payers.
Andy Madigan: Now, specialty pharmacy has been experiencing a tremendous amount of growth during the past decade, as we all know. And prospects for future growth, from all indications seem really strong. But that leaves the opportunities for stakeholders, first and foremost, patients whose prospects are dealing with life limiting illnesses due to advancements in pharmaceutical science and treatment, are greatly improved.
Andy Madigan: So it also brings though, a number of challenges as these treatments tend to be quite expensive and finding ways to ensure that patients can access these medications in our complex health system, are where the efforts of large institutional players, like manufacturers, health plans, PBMs and providers, health system pharmacies, as well as independent specialty pharmacies, have been focused.
Andy Madigan: So a lot of moving parts and the state of specialty pharmacies survey and report has been published to gather perspectives from each of those different important stakeholders. So that said, and before we get into it, I’d like to let our listeners know that they can obtain their own copy of the 2019 State of Specialty Pharmacy report through the following URL and that URL is csigroup.net/survey. Again, csigroup.net/survey.
Andy Madigan: So with that, Brendan, let’s dig into the report. As I mentioned, it’s organized into four sections, manufacturers, health systems, specialty pharmacies, independent specialty pharmacies and payers. For our episode today, we’ll be focusing on health system specialty pharmacies. The others will be covered in separate episodes. So Brendan, on a top level, are there any notable findings that you’d like to call out?
Brendan R.: Yeah, I think that when you look at the health system, especially pharmacy responses, if you looked, 40% of respondents see the industry growing and actually capturing more of the market moving forward. There’s a lot of optimism around this. And I think a lot of that has to do with the fact that we’re seeing … You had your entry level health systems who were kind blazing trails with setting up specialty pharmacies and a lot of people didn’t quite understand the impact of that.
Brendan R.: Now we’ve seen a lot of the other health systems take notice and are really kind gravitating towards that. So we’re not just increasing the number of health systems starting up specialty pharmacies. You’re talking about new levels of maturity that a lot of the health systems are reaching. So they’re really maturing their offering there. You really go from one or two disease states, to really servicing all of the disease states that they have with their patient population.
Brendan R.: The other thing too, is they’re really finding ways to leverage their services across the health system, working very closely with the care team, working very closely with providers to ensure wraparound services for pharmacy.
Andy Madigan: Are there any ways that the health systems are uniquely positioned relative to other providers to experience growth in the years to come?
Brendan R.: Completely, they’re really placed to fill in the gap of a specialty pharmacy. If you look at the access that they have to the providers, the care team, the turnaround time that’s associated with being able to initiate therapy. They have access to the entire electronic health record.
Brendan R.: You’re not having to work through or go through a conduit to try to gather the information, really it’s at their fingertips. And really as we look at this, the health systems are really starting to really focus on patient navigation. In other words, this patient, instead of just writing the script and the patient going to the pharmacy and finding out that they’re on a therapy that requires this, this and this and they have no idea what the steps are going to be associated with us.
Brendan R.: Really the health systems are trying to fill that gap and helping that patient navigate through all of this. So helping them with prior authorization, helping them with financial assistance, explaining to them what’s going to happen, explaining to them the benefits of this and then providing that feedback to the care team. Hey, this patient has gotten prior authorization, they’ve gotten financial assistance. This is going to be filled and it’s going to be filled at this location.
Andy Madigan: One of the things that this subset, the health system specialty pharmacies was asked to answer on the survey was what some of their greatest challenges have been to grow. Can you talk about what some of those were?
Brendan R.: Yeah. I think that the biggest concern or the biggest fear that is being brought up was that payer getting locked out of payers, also, limited distribution access items. Really when I look at the main thing that I hear about is when I’m out consulting, is I always hear about the worry about the PBM owned pharmacies and the percentage of the scripts that you’re able to fill and having problems getting into network.
Brendan R.: There are going to be forced provisions in a lot of PBM agreements. But if you get the first pill, if you get the second pill or you provide the wraparound services to making sure that you’re transitioning that patient to the appropriate specialty pharmacy and you start to build that story about your role and the importance of you, being in that whole equation, which ultimately impacts your future in regards to your payer agreement.
Andy Madigan: What advice would you give a health system for addressing some of the challenges that are commonly cited by that subgroup, in lock out of payer networks and having that access to enough staff to handle the growth and those sorts of things?
Brendan R.: Yeah, so in regards to the payers, payer strategy is one of those things that I considered to be a local strategy. Are there employers in the area that only have a facility in your area, where maybe 80 to 90% of their medical volumes or their patients see your specialist? Are there opportunities to, in other words, when you’re negotiating medical or trying to go after the pharmacy benefit as well, and are there opportunities for the plan sponsor to carve you in to the pharmacy benefit, so that way they could utilize, the patients could utilize your pharmacies.
Brendan R.: It’s very hard to go to a company that may have facilities in 15 states and to really tell that story about why they should include you in network. So I focus a lot on the payer strategy being a local strategy. The other thing too, is working with the individuals within your health system that are actually writing or negotiating the medical agreements.
Andy Madigan: Right.
Brendan R.: To see whether they would include the pharmacy benefit in that. If you’re at the negotiation table and you’re talking about fractions of percentage points in regards to that medical benefit, are there opportunities for you to make that up on the pharmacy, if they would include your pharmacies in network, is just some of the items that we’ve seen.
Andy Madigan: Looking again at the State of Specialty Pharmacies survey, one of the noteworthy trends has got to be the number of health systems that are forming their own PBMs. What do you make of that?
Brendan R.: I’d have to say that, if you look at the for profit area, there’s been a lot of vertical integration amongst payers purchasing PBMs and I think that when you look at health systems, it’s one of those, they’re seeing the for profit entities, gravitate towards that. They’re in a situation where if they have, lots of times they’re the largest employer in the actual area.
Brendan R.: And sometimes they want to create pharmacy services and to be able to fill the specialty scripts for their patients and having your own PBM or having your own PBM that’s operated by a PBM are things that health systems consider. So that way, they can control exactly where those scripts go to and what’s in network, but also giving them the opportunity to utilize the 340B benefits.
Andy Madigan: Right. Another interesting finding was the response to the question, if they’re not currently offering home infusion services, how likely are they to consider offering those in the future, within the next 24 months? And about 2/3 indicated that they were considering that. What do you make of that?
Brendan R.: Yeah. Infusion pharmacy is one of those cyclical things. A lot of health systems had them, they got rid of them and now they’re evaluating, do we need to bring those back? If you look at providing wraparound services and being able to transition a patient to home, let’s say if a winter storm or something’s hitting your area and you do not have a home infusion company that’s associated with your health system, that’s internal. Discharging those patients, being able to transition them home. If you have your own team, your own services, A, you can help transition those patients to home a little bit smoother.
Brendan R.: You have insight into what’s going on with their care. Id have to say the biggest reason why I think a lot of people are considering this is really site of care. A payer no longer will reimburse you or you’re losing dollars in regards to your infusion sites. Is there opportunities to push that to home infusion?
Brendan R.: And if you don’t have that as an option, being a health system, it is either you administer it at an infusion site or you lose business and you lose the potential 340B benefit associated with that as well. So it’s providing that wraparound service and to really give patients the ability to, in other words, get their care from the health system.
Andy Madigan: Okay. So Brendan, as the market has matured with health system specialty pharmacies, we’re seeing not as many startups, more and more of these health systems have a specialty pharmacy and have had a specialty pharmacy for some time. It’s becoming more of the opportunity for optimization and creating efficiencies and that sort of focus in the market. Can you talk to that a little bit?
Brendan R.: Yeah, I think that a lot of people in the specialty pharmacy area were really focused on the percentage of prescriptions that they were able to fill. And I always recommend less focus on filling percentages and making sure your care team is successfully triaging your specialty prescriptions.
Brendan R.: We actually had a client that was able to get 90% of their specialty prescriptions sent to their specialty pharmacy. They’re seen as a part of the care team. They’re seen as a resource that can provide white glove service for the patients, that are ultimately freeing up the other care team members.
Brendan R.: So I think one of the things that I focus in on is less on the percentage of which you can fill, versus increasing your at bat percentages. With a higher number being sent to you, you get more chances to fill that. And we quite often find that people will beat their budgets or beat their goals, just by increasing those opportunities versus solely focusing on fills.
Brendan R.: And really, that’s really tied to having a dedicated specialty team that can really provide those white glove services, identifying if it’s a new prescription or continuation of therapy, getting prior authorization, seeking financial assistance if there’s funds available.
Brendan R.: When we look at this, programs are always changing and someone goes in as additional duty, let’s say a nurse who’s at the end of their day trying to get some of the paperwork done. They find that there’s no funds available in the foundation. Really, if you look at the difference between having somebody that does it as another duty, as assigned versus somebody that’s dedicated, that’s doing it 100% of the time, they’re going to be more effective, efficient, and they’re going to know the inner workings of all of this stuff.
Brendan R.: So really the whole goal of the health system specialty pharmacy is really trying to provide that white glove service, which is ultimately going to free up your providers, your nursing and your case management staff. And when you get to that point where you’re providing white glove service, you know it’s good when the providers start asking, when are you going to get to my service or they become proponents for your specialty pharmacy.
Brendan R.: So in regards to getting access to products where the physician or the care team talks about, hey, this specialty pharmacy service within our health system provides complete wraparound services, they give me a feedback on your care, they’re part of the care team. All of that promotion helps the health system pharmacist.
Andy Madigan: That’s good advice. Thank you very much, Brendan. That’s all the time that we have for today with this episode. And I want to thank Brendan Reichert for joining us and sharing your insights with us. And thank you for listening to the CSI Specialty Pharmacy podcast. If you’ve enjoyed listening today, I encourage you to subscribe to the podcast on your favorite podcast delivery platform.
Andy Madigan: If you have questions about today’s episode or you’d care to share some feedback, you can reach us at podcasts, that’s podcasts, plural, at csigroup.net.
Andy Madigan: I also encourage you to visit our website, csigroup.net and there you can download your free copy of the 2019 Specialty Pharmacy Report. Again, that URL is csigroup.net forward/survey and you can also keep up with us on social media by following CSI specialty group on LinkedIn, Twitter, and Facebook.
Andy Madigan: CSI specialty group is the subsidiary of group purchasing organization Intalere. CSI expands Intalere’s suite of solutions to healthcare providers, health systems, pharmacies, and pharmaceutical partners. Intarlere is owned by Intermountain Healthcare, a leading healthcare system based in Salt Lake City, Utah. CSI supports our parent organization’s vision of providing tailored, smart solutions to help deliver superior services at an affordable cost.
Andy Madigan: You’ve been listening to the CSI Specialty Pharmacy podcast. Until next time, good day.